Healthcare Provider Details

I. General information

NPI: 1265933352
Provider Name (Legal Business Name): INGRIS MALDONADO PHD-MHLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 CENTER RANCH LAKE BLVD
ST. CLOUD FL
34771-6202
US

IV. Provider business mailing address

5330 CENTER RANCH LAKE BLVD
ST. CLOUD FL
34771-6202
US

V. Phone/Fax

Practice location:
  • Phone: 407-744-5447
  • Fax: 407-744-5447
Mailing address:
  • Phone: 407-744-5447
  • Fax: 407-744-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2712
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4375
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number25561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: